KANDAHAR — For more than two months I have been working every day in the children’s ward of Mirwais Hospital in Kandahar in southern Afghanistan. My main task is to work with the local pediatric nurses, to pass on my nursing experience to them in as sustainable a way as possible, to assist them in emergency situations, and to support the head nurse, Sister Alia, in her work of directing the children’s clinic on the nursing side.

Unfortunately, we see many young emergency patients. Mirwais is the only hospital within a radius of several hundred kilometers, and treatment is free of charge — help is offered to everyone, to the extent of need.

Every day we see malnourished children, children with infectious diseases which could be vaccinated against, children with chronic illnesses that require regular treatment and children with diarrhea, because there is often no clean water. Often the lack of health infrastructure and poor accessibility of hospitals and physicians is to blame.

Each work day begins at 7.45 a.m. with the drive to the hospital 500m away, along with the entire I.C.R.C. team of doctors, nurses, caregivers, and the so-called “field officers” – our translators, who are all nurses or midwives and therefore do much more than translate.

This morning Britta, a Danish pediatrician, and I were greeted in the hallway by two men who gave us to understand through gestures with their hands and feet that we should go to the intensive care unit.

Jacoub

Essa Mohammed and Omar Shah, the pediatric nurses of the night shift, were, with Dr. Ammanullah, already giving treatment to little Jacoub, who had just been brought in by his entire family.

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Ill for more than eight days with pneumonia, the three-year-old boy’s condition was now very serious — septic shock was the diagnosis by colleagues, who were about to administer infusions and prepare urgently needed antibiotics. His respiration was very fast, so we decided to provide oxygen to give additional relief to his breathing with the anesthesia bag. Five of us spent nearly 30 minutes giving the initial treatment. Then there were blood samples to be examined in the laboratory and medication to be given. Jacoub also received about half a liter of saline infusions. His respiration, pulse and blood pressure had stabilized somewhat, and his family was already resting after the long and tiring journey, filled with concern for their first-born son.

Meanwhile, my colleagues on the day shift arrived, eight pediatric nurses from Kandahar and surrounding areas. The head nurse Alia, is the only woman in the department, and together we make a tour every morning, looking at the patients and talking to the families. That day there were 85 patients. We knew most of them from the day before, and besides Jacoub, four children were admitted overnight.

Roshana

After the morning tour we had just arrived at Alia’s office to discuss the tasks of the day when Faith, our Kenyan midwife, called me by radio to come to the delivery room to assist a newborn.

Aspiration, respiration and stimulation of the newborn girl had to be carried out very quickly: the birth had been very long and exhausting, which led to her having problems of adjustment with her breathing and circulation. After the first ten minutes of little Roshana’s life, in which Faith and I managed to stabilize her breathing and keep her warm, we decided to take her to the children’s ward and to place her in an incubator. Shamshullag, our neonatal nurse, had already prepared it with oxygen and intravenous fluids, even as he was busy documenting the vital signs and administering medications to the seven other newborn and premature infants in the neonatal room.

Back in Alia’s office, we made arrangements for the day’s planned training course. The nurses had asked to learn more about the safe taking of blood samples to make blood cultures. Then we had some time to talk about one or other of the patients, and to discuss new ideas. Jacoub’s and Roshana’s condition had improved considerably, it had been a really close thing for Jacoub.

Training

At lunch we finally met everybody for the scheduled training session. We discussed the action together step by step, and the experienced nurses shared their knowledge with the others. After training, it was then, as usual, time for lunch and for my Afghan colleagues to pray.

The afternoon hours in the children’s clinic are usually quieter, and so it was on this day. All emergency patients who arrived overnight or during the morning were fed and examined, given medication and we spoke with their companions. In the afternoon I usually try to spend much of my time in general pediatrics, as there is often less time for that department in the morning. Emergencies in the neonatal room and the intensive care unit normally require our full attention.

Three Young Men

In the late afternoon three young men were brought in by their relatives. They were dead, shot from a short distance. One in a public toilet in town, I was not sure about the others. They were further victims of a recent trend of targeted assassinations. Another young man, almost still a child, came in by taxi with his grandfather. He was shot in the leg and was brought in by an I.C.R.C.-supported taxi network.

Since we cannot travel to most areas due to insecurity, and without functioning ambulance systems outside the city, we resort to creative solutions to bring patients to us. He might be a fighter or a civilian who was at the wrong place at the wrong time. All the same to our medical staff, he needs treatment.

Khadija

One patient was Khadija, a seven-year-old girl whom I had known for almost two weeks now. She was suffering from meningitis and tuberculosis. Her life-threatening condition had improved rapidly at first, but the healing process turned out to be lengthy. Although she was conscious — indeed, talking, sitting or playing — normal things for children of that age were still far off for her.

So for several days whenever there was time Zinullah, a nurse, and I tried to draw Khadija out a bit. On this day we finally wormed out a whole sentence, in addition to a smile, to which we have become accustomed. That pleased us very much. Zinullah then proposed also inviting the physiotherapists to help Khadija’s progress even further. A great idea, which he immediately discussed with the physician who was treating her.

A Good Day

Whenever someone asks me how the work here in Kandahar is different from my everyday life in Germany, it is difficult for me to describe. Almost every day here is more restless than at home, but you get more direct feedback from loved dependents, parents and patients. For example, after the great improvement in Jacoub’s condition this morning.

Unfortunately not all children have as much luck in Kandahar, although the Afghan nurses and physicians perform the unimaginable every day.

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At the end of the day the team met near the car park to drive back the 400 meters along the dusty city street to our compound. The chatter in the Land Cruiser was mostly about the fighting last night. I closed my eyes and let the day’s events pass in front of my eyes like a movie without sound. There was no unusual influx of patients, as we are used to seeing following a bomb attack. The generators worked well, Roshana had survived and Khadija was making progress. The young man with the bullet wound would lose his leg, but our doctors seemed hopeful for young Jacoub.

“All things considered,” my colleagues said, “it was a good day.”

Mirwais regional hospital is a government-run 380-bed medical facility in Kandahar City. It serves a population of around four million across southern Afghanistan. With up to 800 operations a month, it is one of the busiest hospitals in the country. The hospital is supported by two dozen I.C.R.C medical specialists, nurses, surgeons, gynecologists, nutritionists and doctors, and by engineers and general staff.

A short I.C.R.C. film about the hospital is on YouTube, here, and a photo gallery here.

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